The slides came from an earlier Dr. Rohack AMA presentation and are included with my notes.

1. Dr. Rohack established a base line with a brief history of healthcare and insurance dating back to before the Great Depression. During the Depression, FDR called for Universal Coverage AGAIN. Child Health Insurance Plan Teddy Roosevelt When LBJ established Medicare & Medicaid, the average lifespan was 68 years, and benefits didn’t start until age 65. Now the average lifespan is 78. Employers got tax benefits from offering employee healthcare.Workers were not taxed on it.

2. Technologies from NASA’s space program, such as vital sign sensors, have helped people to live longer, but that has caused Healthcare costs to increase even faster in the US than other nations. [Wayne: It’s likely that technologies for home and mobile healthcare could again extend the average lifespan while increasing costs further.] AMA Principles of Health System Reform: Coverage for all Americans Insurance market reforms Protection of patient – physician relationship Quality improvement, prevention and wellness Protection of seniors’ access to care Medical liability reform Streamline insurance claims processing

4. Increased regulations and administration

6. More than 46 million uninsured

7. Medicaid & Unemployment on the rise

9. Many baby boomers found their retirement savings depleted from today’s depressed economy and must now continue working much longer than expected. Many adult children found themselves burdened with so much debt that they want to move back home, and National budget woes will likely increase their burden.

10. The objective of Obama’s Health Care Plan is to slow the growth of health costs, and while some items may actually raise costs, the overall result is expected to save some $2 trillion by 2019.

11. Rising Medicare costs are projected to reach 24% of all Federal Income Taxes by 2019 and 51% by 2042. Such increases are unsustainable.

12. Healthcare costs balloon in the last 6 months of life, often with procedures that are either medically unnecessary or unwanted by the patient, but proposals to fund End-of-Life counseling became politicized as “death panels.” Close to half (43.1%) of annual Medicare expenses go toward just 5% of beneficiaries.

13. It’s notable that Dr. Rohack represents Texas, which has one of the worst healthcare systems and over 5.8 million uninsured people live here. Maybe that’s why he’s been so active in health policy and in serving as a past AMA President.

14. People without health insurance get less preventative care and rely heavily on charity and the emergency room of for-profit hospitals that are not allowed to turn away emergencies.

15. The use of hospital facilities declines significantly as income increases but then heads back up for wealthier patients because of elective and cosmetic surgeries.

17. Health system-related factors

18. Practice-related factors

20. Disease knows no ethnic or racial barrier

22. Over a million people die each year because of smoking, drinking and obesity – behaviors they could control but decide not to. Many people don’t want their taxes to go toward providing care for people who choose not to care for themselves, and this is just one of the many ethics questions being debated.

23. Speaking of obesity, this chart shows ne number of obese adults more than doubling since 1990.